Palliative care phases

In PCOC, a palliative care phase describes a stage of the patient’s illness within an episode of care and provides a clinical indication of the level of care required. There are 4 palliative care phases used in PCOC—stable, unstable, deteriorating and terminal. When assigned, the first three phases reflect the effectiveness of the plan of care and the urgency of response to patient and family care needs. The terminal phase is assigned when the patient is likely to die within days. It should be noted that palliative care phases are not necessarily sequential: a patient may transition back and forth between phases during an episode and there is also likely to be more than one phase of care within an episode.

There were 153,108 palliative care phases reported to PCOC in 2019, with just under half (48.5%) occurring in inpatient palliative care. Of these, just over one-third (34.9%) were in a deteriorating phase followed by stable (25.5%) and terminal (21.0%) phases. Of the 78,926 phases reported in the community care setting, 42.6% were in a deteriorating phase, followed by stable (37.0%) and unstable (12.7%) phases (Figure PCOC.5).

For both the inpatient and community care settings, the average phase length (elapsed days) was highest for the stable phase (6.5 days and 20.3 days respectively), followed by the deteriorating phase (5.0 days and 12.0 days respectively) and the terminal phase (2.0 days and 3.0 days respectively).

Vertical bar chart showing the per cent of phase counts of palliative care phases by inpatient and community settings. 25.5% of phases in inpatient setting and 37.0% in community setting were Stable; Unstable, 18.6% and 12.7%; Deteriorating, 34.9% and 42.6%; Terminal, 21.0% and 7.7%. Refer to Table PCOC.9.

Source: Palliative care outcomes tables (192KB XLS)

Palliative care outcome measures and benchmarks

In 2009, PCOC and participating services, developed and implemented a set of national outcome measures and associated benchmarks to drive service innovation and allow participating services to compare their service nationally. These outcome measures cover:

  1. time from date ready for care to episode start (Benchmark 1)
  2. time patient spent in an unstable phase (Benchmark 2)
  3. change in symptoms and problems (Benchmark 3).

In 2015, six additional measures relating to fatigue, breathing problems and family/carer problems were introduced. A full description of each of the PCOC benchmarks reported here is shown in Table PCOC.13. PCOC also reports on 8 casemix adjusted outcomes measures, not reported here.

Based on PCOC palliative care outcome benchmark results, in general, patients receiving inpatient care are more likely to achieve better outcomes than patients receiving community care (Figure PCOC.6). Research conducted by  Eager, Clapham and Allingham (2018) found that over 85% of palliative care patients had no severe symptoms prior to death, and fewer hospital patients overall experienced severe distress from symptoms just prior to death than patients at home.

A high proportion of all patient episodes (92.6%) commenced within two days of the patient being ready (Benchmark 1) whilst 88.3% of patients spent 3 days or less in the unstable phase (Benchmark 2). Positive outcomes were achieved for 94.0% of patients beginning a phase with absent to mild breathing problems (Benchmark 3.7).

The majority of patients experienced no more than absent or mild symptoms or problems. For those patients who did experience moderate to severe distress from fatigue, 45.0% had this reduced to absent or mild (Benchmark 3.6). Similarly, moderate to severe distress from breathing problems was reduced to absent or mild for 47.9% of patients (Benchmark 3.8). Over half (56.0%) of patients who began experiencing moderate to severe distress from pain had this improved to absent/mild (Benchmark 3.4). Achieving an absent/mild symptom (or problem) outcome is less likely when the patient has moderate or severe symptoms (or problems) to begin with as is reflected in the outcome results.

Vertical bar chart showing PCOC palliative care outcome benchmark results, by inpatient and community care settings. 97.7% of episodes/phases in inpatient settings and 86.3% in community settings met benchmark 1; Benchmark 2, 90.0% and 86.0%; Benchmark 3.1, 92.4% and 86.1%; Benchmark 3.2, 63.9% and 58.4%; Benchmark 3.3, 90.9% and 85.2%; Benchmark 3.4, 58.3% and 53.6%; Benchmark 3.5, 91.3% and 82.0%; Benchmark 3.6, 53.1% and 38.9%; Benchmark 3.7, 95.6% and 92.6%; Benchmark 3.8, 53.7% and 42.2%; Benchmark 3.9, 93.5% and 83.5%; Benchmark 3.10, 55.3% and 48.4%. Refer to Table PCOC.13.

Source: Palliative care outcomes tables (192KB XLS)

References

ABS (Australian Bureau of Statistics) 2017. 2016 Census: Multicultural (media release). Canberra: ABS.

ABS 2018a. Estimates of Aboriginal and Torres Strait Islander Australians, June 2016. ABS cat. no. 3238.0.55.001. Canberra: ABS.

ABS 2018b. Socio-Economic Indexes for Areas. Canberra: ABS. Socio-Economic Indexes for Areas. Canberra: ABS. Viewed 7 May 2019.

ABS 2020. Estimated resident population, Country of birth, Age and sex - as at 30 June 1996 to 2019. ABS cat. No. 3412.0. Canberra: ABS.

Eagar K, Clapham SP, Allingham SF 2018. Palliative care is effective: but hospital symptom outcomes superior. BMJ Supportive & Palliative Care. 31 August 2018. doi: 10.1136/bmjspcare-2018-001534.

Palliative Care Outcomes Collaboration (PCOC) 2012. PCOC Version 3.0 Dataset, Data Dictionary and Technical Guidelines. Document version 1.2.0. Wollongong: Australian Health Services Research Institute.